Intravenous iron-sucrose, Pregnancy, Severe anemia
DOI: 10.5005/jp-journals-10065-0039 |
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Kumari A, Rai S, S. Study of Increase in Hemoglobin Concentration after Administration of Intravenous Iron Sucrose in Pregnant Women with Severe Anemia. World J Anemia 2018; 2 (3and4):79-84.
Introduction: Iron-deficiency anemia is a great concern among obstetricians. Anemic women are at a greater risk of dying during their pregnancy. Despite the measures taken to control anemia in pregnancy in the last two decades, the severity of nutritional anemia continues to remain a public health issue of great magnitude. Oral supplement or iron has several drawbacks. Hence an idea was conceptualized to conduct a study to evaluate the efficacy of IV iron sucrose (OROFER-S) in the improvement of hemoglobin concentration in the antenatal mothers with severe anemia. Materials and methods: This progressive study was conducted in antenatal OPD of obstetrics and gynecology department of VSS Medical College, Burla, Odisha for a period of 24 months. Results: Out of 23 antenatal mothers with severe anemia, 73.91% were residing in rural area and 26.08% were residing in urban area. The cases recruited in the study were given a total of 300 mg elemental iron as iron sucrose complex diluted in 0.9% of NS per week. Hemoglobin level was estimated at the onset and again two weeks after the completion of the study. On completion of therapy, there was significant improvement in Hb level with a rise of Hb level (2.5–3) in 4.3% mothers, and (1.5–2) g/dL in 60.66% cases. No rise in Hb level was observed in 8.6% cases. Present study shows correlation between severity of anemia and gravidity with multigravida accounting for 65.21%. Most of the patients (39.13%) were just literate or had primary education (26.08%). The study groups faced only minor side effects like nausea (21.73%), shivering (13.04%), no serious anaphylactic reactions were observed. Low birth weight (47.82%) is the most common fetal complication. Further IUGR accounts for 34.78% and premature labor (13.04%). Gestational hypertension (21.73%), postpartum hemorrhage (17.39%) and preterm labor (3.90%) and the common maternal complications observed.
Anemia is known to be a common and clinically important cause of chronic kidney disease (CKD). With progression of CKD, various factors can be attributed to reduction in hemoglobin (Hb) levels. However, reduced production of erythropoietin (EPO) due to impaired functioning of kidneys remains the central cause. The most effective treatment of anemia associated with CKD involves iron replacement and erythropoietic-stimulating agents (ESAs). Diagnosis of iron-deficiency anemia (IDA) in CKD patients is complicated due to the relatively poor predictive ability of routine serum iron indices such as ferritin and transferrin saturation. Invasive methods such as bone marrow iron stores or erythropoietic response to supplemental iron for detection of iron deficiency serve as the gold standard and are required for confirmation of diagnosis.
Sickle cell disease (SCD) is the most common hereditary disease globally, linked with anemia and recurrent severe pain. Pregnancy in a patient with SCD is related with high levels of maternal and fetal morbidity and mortality. Studies on potential complications during pregnancy have generated mixed data. However, it is generally accepted that women with SCD are at higher risk of adverse pregnancy outcomes and maternal mortality. Patient care has developed much over time. Nevertheless, some of the definite management issues still remain unanswered. Excellent prenatal monitoring and aggressive intervention should be established when difficulties arise for the effective management of the pregnant patient with SCD. This article discusses the etiology and the diagnosis including the clinical presentation, investigations, neonatal screening, peripheral smear, and the available management options.
Twin-to-twin transfusion syndrome (TTTS) is a severe problem that affects 10–15% of monochorionic (MC) multiple pregnancies. Connecting placental vessels on chorionic plate between donor and recipient twin is accountable for inequality of blood flow. There is an indication for the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II–IV TTTS. However, the optimal management of stage I is still debated. In this review, we discuss the basics of twin gestation, optimal management, pathophysiology, long-term neurodevelopmental outcome, and future aspects of TTTS.
Anemia is a rapidly growing cause of concern among the aged population (age older than 65 years) in the world today. It is often multifactorial and remains underdiagnosed, especially in case of nutritional anemia because of its ability to stay insidious for a long period. Furthermore, it has been predicted that the population of the elderly is continually increasing due to the advancements in medical technology and healthcare system, better access to medical facilities and due to enhanced awareness to live a healthy lifestyle. All these factors contribute to increased longevity in the elderly. This is also one of the reasons for increased burden on the healthcare system, as this segment of population is the most vulnerable for developing serious medical conditions such as anemia. Anemia is natural consequence of the process of aging and poses high risk of developing diseases in the older people along with decline in physical performance, increased morbidity and poor quality of life. This article aims at providing useful insights into various factors responsible for developing nutritional anemia. It also aims to provide understanding of relationship between aging and anemia, and summarizes recent management options available for nutritional anemia in the aged population.